Resumo

Objectives: At present the use of HA dermal fillers for Non Surgical Rhinoplasty (NSR) are based on the concepts learned from surgery, and are injected into the deep or superficial planes. However, this technique is not free of certain controversy due to the risk of adverse events, and it is fundamental to select the right candidate to undergo this procedure. The main goal of this paper is to present 3 case-study patients in order to show the versatility and safety and of an innovative injection technique for nose sculpturing with hyaluronic acid (HA) filler. Introduction: Rhinoplasty is one of the most popular surgeries worldwide, with more than 852.000 procedures worldwide performed in 2020. Despite rhinoplasty has experienced significant advances over the last years, it remains currently one of the most challenging surgical aesthetic procedures. Due to the development of new hyaluronic acid dermal fillers, nonsurgical rhinoplasty (NSR) has become increasingly popular among patients who want to improve the aesthetic aspects of their nose. Additionally, NSR has been associated with lower cost, lower risk of adverse effects and shorter downtime. Materials / method: Three types of patients: A - standard indication for NSR (nose with minor aesthetic flaws); B - post Surgical Nose (one year after surgical procedures); C - Extreme NSR (patient with surgical indication who couldn’t undergo surgery). A 25 mg/mL HA filler was administered by using a syringe with a fixed microneedle (30G/8mm). All patients were injected at three key nose points: Radix and Dorsum (maximum 0.3 mL); Tip (maximum 0.2 mL) and Columella (maximum 0.3 mL). Primary endpoint was patients' satisfaction at 12 months which was assessed by using a five-points Likert scale. Results: The average volume of HA injected was about 0.6 mL (from 0.2 to 1 ml). Patient B was treated with a much lower volume (0.2 ml) compared to others. Touch-up was performed one month after the first treatment (range 0.1 -0.3 ml). All patients were very satisfied with the outcomes and would like to undergo a new treatment. One year after the first session the volume of filler injected in the second session was between 0.1 and 0.5 ml. Only moderate reactive events immediately after procedure (such as swelling and hematoma) were reported and successfully controlled with medical therapy. Conclusion: This technique was versatile, effective, predictable and relatively safe, with high patient satisfaction. An adequate knowledge of nose anatomy is essential for avoiding adverse events and obtaining satisfactory outcomes. NSR is indicated for the correction of mild aesthetic/cosmetic nose deficits in different types of patients including those which do not accept the costs/risks of surgery. Giammarioli, G, Liberti, A. Non-surgical rhinoplasty technique: An innovative approach for nasal reshaping with hyaluronic acid fillers. J Cosmet Dermatol. 2023; 22: 2054-2062. doi:10.1111/jocd.15669